Planning systemic investigations Tom Morgan and Emer Doyle

Systemic investigations – a general overview Tom Morgan Senior Investigator Office of the Ombudsman

How do we unearth systemic issues? Training caseworkers to be alert to issues Trends from Complaint Examination System (CES) Close monitoring by Heads of Units Sectoral leads – “scanning the horizon”, Dáil and Committee debates, newspapers, specialist publications, NGOs, other regulatory bodies Quality Assessment audits “Own initiative” powers

Deciding whether to investigate or not Is it likely to impact on a large number of people, complainants and non-complainants? What is the likely scale of the adverse affect? Can the Ombudsman make a meaningful impact? Are there other sources that could potentially resolve the matter? Resource requirements

Deciding whether to investigate or not Is the matter attracting a lot of public attention? Is there any urgency about the matter which requires a quick intervention? The timing may be right Reputation – think about it – don’t bite off more than you can chew!

How do systemic difficulties arise? Periods of austerity leading to inflexible administration and fettering of discretion New organisations / units not properly prepared to administer the tasks Local delivery of central policy/schemes – inconsistency, incorrect interpretations Transfer of local delivery to centralised delivery Lack of communication between different service providers

Previous investigations / systemic issues “A Good Death” – end of life care Thematic “look back” High impact but low level resource Importance of launch and design

Previous investigations / systemic issues Local Authority loans – one case – widespread impact Long Term Illness Care investigation – localised administration – countrywide solution Social Work investigation – a partial “look back” – timing – High Court judgment 2006 890 JR Student Universal Support Ireland (SUSI) – widespread adverse affect Treatment Abroad Scheme – centralised administration – serious adverse affect Homelessness

Learning to Get Better – a practical example Emer Doyle Investigator Office of the Ombudsman

into how public hospitals handle complaints Learning to Get Better An investigation by the Ombudsman into how public hospitals handle complaints

This investigation looked at How well the HSE and public hospitals listen to feedback and concerns Whether the HSE and public hospitals are learning from complaints to improve services

Why investigate? Despite the high number of interactions with public hospitals, relatively few complain to this Office about the service received 20% of complaints to this Office are about the health service (including public hospitals) – over 60% in Northern Ireland We wanted to find out why this was and We wanted to make sure that the complaints system available was effective

This report A constructive report We wanted to highlight good practice in complaint handling where it exists Bright spots so hospitals can learn from each other

Methodology An “own initiative” investigation Three strands - involved reaching out to members of the public including focus groups Surveyed all public hospitals on their complaints processes and visited 8 hospitals across the country for a more in-depth look at their processes Engaged with a wide range of stakeholders including advocacy groups, regulators and representative organisations

Engagement with public Investigation announced in June 2014 Public invited to make submissions using specially designed form Freepost address Also set up designated e-mail address – hsecomplaints@ombudsman.gov.ie Just over 30% used form to make submission Majority of submissions (57%) were from relatives and/or carers

Engagement with public All submissions were responded to – some were set up as valid complaints with consent 16 people were chosen to take part in focus groups (run by outside company following a tendering process) Two focus groups held – one in the afternoon and one in the evening

Engagement with public Participants in focus groups included those who had considered making a complaint to the hospital but did not made a complaint informally to the hospital made a complaint to the hospital Complaints Officer but did not pursue the matter further after that made a complaint to the hospital Complaints Officer and subsequently requested a review of the matter from either the HSE or this Office

Engagement with hospitals / HSE Issued a survey to all public hospitals re: complaints processes and level of signposting 100% response although some needed reminding! Asked to supply examples of patient information booklets, posters, etc.

Engagement with hospitals / HSE Chose 8 hospitals to visit – at least one from each hospital group including a maternity hospital and a mental health facility. Asked them to complete a more detailed survey prior to our visit. Spent one day in each of the hospitals meeting senior management, Complaints Officers and frontline staff and walking around hospital Randomly selected 6 hospital complaint files from each hospital for examination

Engagement with hospitals / HSE Met with Senior Management from the HSE including Acute Hospitals Division and the Quality and Patient Safety Division Met with senior officials from the Department of Health

Engagement with others Issued a survey to a wide range of advocacy groups via SurveyMonkey. Wrote to representative organisations and medical / nursing schools looking for their views on the complaints process. Met with health sector regulator (HIQA) and main professional regulators (Medical Council and Nursing and Midwifery Board).

Resources Staff – 3 person investigation team Lead investigator – average 75% of time Caseworker – average 35% of time Retired staff member – 25 days

Resources Freepost address Focus groups Costs associated with launch, including printing of report and short film.

Short film: experiences when making complaints http://www.ombudsman.gov.ie/en/Publications /Investigation-Reports/Health-Service- Executive/Learning-to-Get-Better/Short-film- about-making-complaints.html